©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Emergency Management Chapter 16

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Routine Preparedness for Dental Team Members Rehearse medical emergencies Establish roles for each employee Check emergency kit and equipment Post emergency contact numbers Post directions to office

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. The Dental Assistant’s Role in an Emergency Observe patient Report concerns to dentist Review medical history Know emergency plan

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Dental Office Emergency Kit Contents: –Blood pressure kit –Oxygen kit –Sterile syringes –Tracheotomy needle © Cengage Learning 2013

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Contents of Emergency Kit Latex gloves and mask Pocket mask Cold compress Blanket

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Contents of Emergency Kit Paper bag –Used to treat hyperventilation Stress-induced –Cupped hands also may be used –Increases carbon dioxide in blood

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Drugs in Emergency Kit Epinephrine (adrenaline) –Used for acute allergic reactions E.g., anaphylactic shock –Uses preloaded syringe Epi-pen –Classified as vasoconstrictor –Serves as cardiac stimulant –Relaxes bronchioles

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Drugs in Emergency Kit Bronchodilator –Albuterol Inhaler –Improves air flow –Does not stimulate cardiovascular system

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Drugs in Emergency Kit Bronchodilator –Patient exhales Breathes in while dispensing drug Repeated –Breathing improves within 15 minutes If no improvement, call and give oxygen

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Drugs in Emergency Kit Antihistamine –Used for allergic reactions Edema, erythema, urticaria, angioedema –Counteracts effect of histamine –Benadryl commonly used

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Drugs in Emergency Kit Antihistamine –Administered by: Liquid Injection Inhaler

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Drugs in Emergency Kit Anticonvulsants –Diazepam Valium –May be given as premed in tablet form to manage stress –Injection form –Controls seizures

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Drugs in Emergency Kit Analgesics –Demerol or Talwin –Administered by injection –Used to manage acute pain or anxiety

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Drugs in Emergency Kit Vasopressors –Vasoxyl or Wyamine –Management of hypotension –Increases blood pressure –Administered by injection

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Drugs in Emergency Kit Antihypoglycemic –Management of hypoglycemia –Tube of cake icing –Orange juice –Cola syrup –Sugar packets

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Drugs in Emergency Kit Nitroglycerin –Management of chest pain –Vasodilator –Route of administration: Translingual Sublingual Transdermal patch

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Drugs in Emergency Kit Spirits of ammonia –Ammonia inhalants Glass tube covered with gauze Broken under patient’s nose –Used to treat syncope

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Dental Check Which emergency drug may be given to a patient experiencing chest pain? –Nitroglycerin

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Cardiopulmonary Resuscitation (CPR) All dental staff must be certified in CPR Phone first and phone fast Certify every two years

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. CABs of CPR Chest compressions Airway Breathing © Cengage Learning 2013

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Foreign Body Airway Obstructions (FBAO) FBAO during treatment –Dental materials fall into throat Common problematic materials –Crowns –Cotton rolls –Gauze

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Treatment of Obstruction in the Conscious Patient Stop treatment Sit patient upright Encourage patient to cough Perform Heimlich maneuver, if necessary

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Heimlich Maneuver in the Conscious Adult © Cengage Learning 2013

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Treatment of Obstruction in the Unconscious Patient Lay patient on floor –Begin CPR using CAB method –Open mouth after giving breath to search for object If airway is still obstructed, continue CPR

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Treatment of Unconscious Adult with FBAO © Cengage Learning 2013

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Dental Check What is the proper order for performing cardiopulmonary resuscitation? –Chest compressions, airway, breathing

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Common Emergencies in a Dental Office Syncope Asthma Orthostatic hypertension Allergic reaction Anaphylactic reaction Hyperventilation

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Common Emergencies in a Dental Office Seizures Diabetic emergencies Hypoglycemia –Insulin shock Cardiovascular emergencies

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Syncope Fainting –Decreased blood flow to brain –Lying still for prolonged periods –Stress Emotional Physical

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Symptoms of Syncope Dizziness Nausea Weakness Pale and clammy skin Shallow breathing

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Treatment for Syncope in the Conscious Patient Place patient in sitting position Have patient place head between knees

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Treatment for Syncope in the Unconscious Patient Place patient in Trendelenburg position Loosen clothing or jewelry Administer oxygen Administer spirit of ammonia under nose

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Trendelenburg Position © Cengage Learning 2013

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Asthma Recurrent episodes of breathlessness accompanied by wheezing Narrowing of airways due to stimulus

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Treatment of Asthma Administer inhaler Administer oxygen Calm patient Call if condition worsens © Cengage Learning 2013

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Orthostatic Hypertension Loss of consciousness or level of consciousness when sitting upright quickly

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Allergic Reaction May be caused by drugs, toothpaste, latex, or other dental materials May vary in severity May cause skin reactions: –edema, erythema, vesicle formation, urticaria, angioedema

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Anaphylactic Reaction Severe, life-threatening allergic reaction Body creates large amount of histamine Tongue and throat swell Causes: –Bee stings –Penicillin –Anesthetics

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Anaphylactic Signs and Symptoms Loss of consciousness Skin rash Drop in blood pressure Nausea and vomiting Shortness of breath Tongue and throat swell

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Treatment of Anaphylaxis Epinephrine

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Hyperventilation Causes: –Deep and rapid breathing –Loss of carbon dioxide in blood Symptoms: –Faintness –Numbness

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Hyperventilation Treatment: –Sit patient upright –Have him or her breathe into paper bag © Cengage Learning 2013

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Epilepsy/Seizure Disorder Unorganized charges in brain cause change in consciousness May be minimal to severe –Grand mal, petit mal, or partial seizures

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Treatment of an Epileptic Seizure Remove dental materials from patient’s mouth Remove glasses and loosen clothing Do not restrain patient

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Post-seizure Place patient in recovery position Let patient recover Reassure patient Patient may: –Be disoriented and exhausted –Not remember seizure –Lose control of bladder or bowel

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Type I Diabetes: Juvenile Diabetes Affects mostly ages 10 to 16 years Associated most often with additional medical problems Usually requires daily insulin injections Comprises 10 percent of diabetes cases Most severe form of disease

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Type II Diabetes: Adult Onset Usually controlled with diet and/or hypoglycemics Does not require insulin injections Seen most often in: –Obese adults –Adults over age 40

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Hyperglycemia: High Blood Sugar Levels Patient has eaten, but not taken insulin Too much sugar (glucose) in blood Not enough insulin

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Signs of Hyperglycemia Increased thirst or dry mouth Excessive urination Acetone breath Blurred vision Rapid pulse Lower blood pressure Loss of consciousness

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Treatment of Hyperglycemia: Diabetic Ketoacidosis or Coma Conscious –Patient administers own insulin, if available Unconscious –Provide basic life support –Transport to medical facility

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Hypoglycemia: Low Blood Sugar Causes: –Overexertion –Emotional stress –Missing meals –Overdose of insulin –Excessive exercising

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Signs and Symptoms of Hypoglycemia (Insulin Shock) Cold sweat Nervousness Trembling Weakness Hunger Personality change Confusion

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Treatment of Hypoglycemia Conscious –Administer sugar source Unconscious –Give injection of glucagon –Administer sugar source under tongue or buccal fold

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Angina Pain in chest area, neck, and jaw Five-minute duration Increased blood pressure and pulse Pale and clammy skin Administration of nitroglycerin –Dilates coronary arteries –Heart receives oxygen

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Myocardial Infarction: Heart Attack Caused by blocked or narrowed arteries Symptoms similar to angina, but not relieved with nitroglycerin One-third of heart attack victims die Heart tissue dies

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Treatment of Myocardial Infarction Call Position patient comfortably Administer oxygen Administer nitroglycerin Administer 160 to 325 milligrams (mg) chewable aspirin

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Congestive Heart Failure (CHF) Inability of heart to pump Fluid collects around ankles and legs Heart progressively weakens Administer diuretics

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Stroke/Cerebrovascular Accident (CVA) Leading cause of death and disability in U.S. Sudden onset –Caused by interruption of blood supply to brain Administer oxygen and call EMS

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Dental Emergencies Abscessed tooth Alveolitis Avulsed tooth Broken prosthesis Soft tissue injury Broken tooth Loose crown

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Dental Check What is the dental emergency shown here? –Broken teeth Courtesy of Dale Ruemping, DDS, MSD

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Monitoring Patients During Treatment Monitoring devices: –Pulse oximeter –Capnograph –Electrocardiogram

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Pulse Oximeter Measures oxygen saturation in blood Noninvasive Diagnoses: –Sleep apnea –Indicator of hypoxia

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Capnograph Detects changes in carbon dioxide levels Noninvasive Usually used in critically ill patients Can be used to detect hyperventilation

©2013 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Electrocardiogram Records electrical activity of heart Noninvasive Detects alterations in pumping of heart